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Fragmented: A Doctor's Quest to Piece Together American Health Care
An award-winning physician-writer exposes how pervasive cracks in the health care system cost us time, energy, and lives―and how we can fix them. There’s an unspoken assumption when we go to see a the doctor knows our medical story and is making decisions based on that story. But reality frequently falls short. Medical records vanish when we switch doctors. Critical details of life-saving treatment plans get lost in muddled electronic charts. The doctors we see change according to specialty, hospital shifts, or an insurer’s whims. Physician Ilana Yurkiewicz calls this phenomenon fragmentation, and, she argues, it’s the central failure of health care today. In this gripping narrative from medicine’s front lines, Yurkiewicz reveals how a system that doesn’t talk to itself puts insupportable burdens on physicians, patients, and caregivers, forcing them to heroic lengths to hold the pieces together―barely. The stories she tells are at once harrowing and commonplace. A patient narrowly averts an unnecessary, invasive heart procedure by producing a worn rhythm strip he has carried in his pocket for a decade. A man diagnosed with leukemia while visiting from abroad has thirty-one physicians, but no one he can call “his” doctor, with tragic consequences. When Yurkiewicz’s own father falls ill, a culture that incentivizes health care providers to react with quick fixes to the problems immediately before them―often to the neglect of a patient’s overall narrative―leads to weeks of additional suffering and a risky hospital transfer. The system is hanging by a thread, and we need better solutions. Yurkiewicz issues a clear-eyed call for change, naming concrete reforms doctors and policymakers can make, and empowering patients and their loved ones to advocate for themselves in the meantime. Urgent, radiantly humane, and ultimately hopeful, Fragmented a prescription for what really needs fixing in modern medicine.
272 pages, Hardcover
Published July 11, 2023
39 people are currently reading
2416 people want to read
About the author
Ilana Yurkiewicz
2 books10 followersIlana Yurkiewicz, MD, is an oncologist, internal medicine physician, and professor at Stanford University School of Medicine. Her science and medical journalism has been published in The Atlantic, Scientific American, Undark, The Best American Science and Nature Writing, and elsewhere. Her first book is Fragmented: A Doctor's Quest to Piece Together American Health Care. She lives in Palo Alto, CA.
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Displaying 1 - 30 of 33 reviews
August 9, 2023
I described this book to a friend as so important, but so angering. So many hoops for both doctors and patients to jump through when we both have the same end-goal in mind-- to make sure the patient is healthy. The work Dr. Yurkiewicz is doing to help ease the fragmentation of the healthcare system is so, so important.
October 1, 2023
4.5 stars, rounded up.
With a daughter in medical school, many of the “fragments” listed in this book are things she has discussed in her short career. Hearing Dr Yurkiewicz’s experiences, along with her solid research, has further convinced me that change is needed. Medical records need to link properly; doctors need more face time with patients and less time with computers; followup needs to be readily available after a hospitalization; etc, etc.
This book needs to be more wide-read. We need to push for change; both medical professionals and patients (current and future) deserve that in order to benefit from the amazing knowledge/skills that exist. I recommend this to everyone, and hope that others do the same.
With a daughter in medical school, many of the “fragments” listed in this book are things she has discussed in her short career. Hearing Dr Yurkiewicz’s experiences, along with her solid research, has further convinced me that change is needed. Medical records need to link properly; doctors need more face time with patients and less time with computers; followup needs to be readily available after a hospitalization; etc, etc.
This book needs to be more wide-read. We need to push for change; both medical professionals and patients (current and future) deserve that in order to benefit from the amazing knowledge/skills that exist. I recommend this to everyone, and hope that others do the same.
April 16, 2024
Wow! I gained a new perspective on our health care system and gained compassion for the doctors who have so many obstacles to treating their patients. Medicine is a science, but it is also an art and an act of love.
January 5, 2024
One of the best books I have ever read. I have underlined and tabbed pages into oblivion. Thank you, thank you for putting into words the experience of doctors and patients.
November 15, 2023
This is a really important introduction to a problem that impacts us all but that is often obscured and insurmountable for most people. Namely, the broken health care system. Yurkiewicz's writing is clear, simple and incredibly readable. She describes that the system is broken from the inside too (she's a doctor), not just from a patient perspective.
She uses personal stories and anecdotes to bring her observations to life, as well as research studies.
Along with the readability, I appreciated the nods here and there to action steps - for doctors, mostly, but for patients too. In the end, though, this book does not present solutions. It's like a canary in the coal mine. It's a cry for a shift in values. Only then can action steps be defined to completely overhaul health care.
She uses personal stories and anecdotes to bring her observations to life, as well as research studies.
Along with the readability, I appreciated the nods here and there to action steps - for doctors, mostly, but for patients too. In the end, though, this book does not present solutions. It's like a canary in the coal mine. It's a cry for a shift in values. Only then can action steps be defined to completely overhaul health care.
April 22, 2025
This author hit the nail on the head! I’ve worked in hospitals for 36 yrs & have long-observed the problems she described. We should all be so lucky to have a doctor like her.
1) Providers aren’t allotted time to scour massive electronic medical records for important details.
2) Patients assume their providers are all communicating (they’re not - esp when patients use providers in multiple medical systems which aren’t connected).
3) Long-term care facilities might as well be secluded islands. In them, patients often receive lousy medical care & staffing is short. Expect errors!
4) If one isn’t acting as their own advocate or they don’t have a good/assertive one, things will go wrong!
5) Everyone should have a PCP with whom they have a good connection. Move on & find another if that respect isn’t there.
6) Like it or not, some of the responsibility for patients not receiving quality medical care falls on patients themselves! (I can write paragraphs on this one.) Unfortunately, if one isn’t paying close attention, important details can easily fall through the cracks. Providers are only human. If they have several hundred - up to 2,000 patients, they can’t possibly get it all right, all of the time!
1) Providers aren’t allotted time to scour massive electronic medical records for important details.
2) Patients assume their providers are all communicating (they’re not - esp when patients use providers in multiple medical systems which aren’t connected).
3) Long-term care facilities might as well be secluded islands. In them, patients often receive lousy medical care & staffing is short. Expect errors!
4) If one isn’t acting as their own advocate or they don’t have a good/assertive one, things will go wrong!
5) Everyone should have a PCP with whom they have a good connection. Move on & find another if that respect isn’t there.
6) Like it or not, some of the responsibility for patients not receiving quality medical care falls on patients themselves! (I can write paragraphs on this one.) Unfortunately, if one isn’t paying close attention, important details can easily fall through the cracks. Providers are only human. If they have several hundred - up to 2,000 patients, they can’t possibly get it all right, all of the time!
August 30, 2023
This book might just be the most important book you will ever read in your life. In fact, all Americans should read this book, because at some point in your life, you will be a patient or the supporting relative of a patient and you will come up against, or be the victim of, fragmented healthcare.
Dr. Ilana Yurkiewicz deftly weaves together her direct experiences from inside the world of medicine with deep, critical thinking about the challenges of systemic breakdown and the consequential outcomes resulting from our flawed and fragmented American healthcare system. She presents an enlightening insider's view of the pressures doctors face, both clinically and morally, as well as relates her own experiences from the "other side of the stethoscope" that come about when her father suffers a cardiac arrest and the fragmented care he received.
Let's face it. American healthcare is a convoluted, inefficient, and dysfunctional behemoth of a system. As Dr. Yurkiewicz peels back the layers to expose the problems, she also presents options for fixing the system and how patients and patient advocates can help while helping themselves navigate through it. Her examples of medical cases, drawn from hers and other doctors' cases, highlight inherent problems with medical care, but also highlight workable and reasonable solutions. That's one of the most valuable aspects of her book.
Fragmented is must read book for everyone. Medical and health care must be looked at with a big picture framing. What is also needed is an understanding that the patient needs to be a part of the team that is providing care. An active and involved patient when possible. One of the first things I did after finishing this book was to photocopy the, "A Patient's Checklist" section. The other, upon returning my copy to the library, was to buy a copy, so I have it for reference. Our healthcare system is imploding. It is reaching a critical point. But one must understand the problems before trying out solutions that can fix it. This critically informative book offers both.
Dr. Ilana Yurkiewicz deftly weaves together her direct experiences from inside the world of medicine with deep, critical thinking about the challenges of systemic breakdown and the consequential outcomes resulting from our flawed and fragmented American healthcare system. She presents an enlightening insider's view of the pressures doctors face, both clinically and morally, as well as relates her own experiences from the "other side of the stethoscope" that come about when her father suffers a cardiac arrest and the fragmented care he received.
Let's face it. American healthcare is a convoluted, inefficient, and dysfunctional behemoth of a system. As Dr. Yurkiewicz peels back the layers to expose the problems, she also presents options for fixing the system and how patients and patient advocates can help while helping themselves navigate through it. Her examples of medical cases, drawn from hers and other doctors' cases, highlight inherent problems with medical care, but also highlight workable and reasonable solutions. That's one of the most valuable aspects of her book.
Fragmented is must read book for everyone. Medical and health care must be looked at with a big picture framing. What is also needed is an understanding that the patient needs to be a part of the team that is providing care. An active and involved patient when possible. One of the first things I did after finishing this book was to photocopy the, "A Patient's Checklist" section. The other, upon returning my copy to the library, was to buy a copy, so I have it for reference. Our healthcare system is imploding. It is reaching a critical point. But one must understand the problems before trying out solutions that can fix it. This critically informative book offers both.
September 6, 2023
A very well written book that blends the author's personal experience and her clinical experience trying to care for patients and their families with disjoined electronic medical records, shortened appointment times to maximize revenue for health care systems that act like commercial, publicly-traded companies, along with work schedules in training that keep medical trainees working in high-stress situations for more than 24 hours straight. She also highlights the benefit to collaboration with other clinicians who can help mitigate concepts like bias and noise in thinking but accurately points out that medical specialization can lead clinicians to think about their particular specialty and miss important pieces of information. At the end of the book she includes a checklist for patients to consider so their health care providers not only get complete information in a systematic way but also includes thinking about values and goals, which are important. However, because there is so much asymmetric information between health care providers and the complex systems they work in, I am not so sure this checklist is particularly novel or will fix the fragmentation she describes in her book. It will take a complete redesign to make it more patient-centric. That said, Yurkiewicz is an engaging, empathetic, physician-author whose book should be read by those within and outside the health care profession. The best advice for patients and their families is to get complete information from your health care professionals and continue to ask questions and if you don't get the information you feel you need, ask to have a family meeting with those who are involved in you or your loved one's care. It will serve notice that your paying attention and health care teams will be more responsive to your concerns.
June 23, 2023
Fragmented: A Doctor's Quest to Piece Together American Health Care by Dr. Ilana Yurkiewicz examines the breaks, the holes, the cracks into which, sadly, many patients fall, not due to a lack of technology, skill, or caring, but because the members of our complex healthcare system, whether human or electronic, don't always communicate clearly or well with each other. Dr. Yurkiewicz identifies many of the issues that cause these fragments, including electronic medical records software that doesn't interface over various platforms, the lack of investment in primary care, and reimbursement models, among others. She poses reasonable solutions that aren't complicated.
Fragmented is well-written, clear and understandable to lay readers. There's no medical-ese or jargon. My favorite lines from Fragmented: "Medicine takes courage. . .Often it takes the most courage not to plow ahead but to pause. . .This courage has an endpoint, and it's to care for one another in a way that is fully human." So true.
A must read for anyone involved in healthcare--whether as a professional or patient.
I received a complimentary ARC from W. Norton & Company, and all opinions expressed are my own. Publication in July 2023.
Fragmented is well-written, clear and understandable to lay readers. There's no medical-ese or jargon. My favorite lines from Fragmented: "Medicine takes courage. . .Often it takes the most courage not to plow ahead but to pause. . .This courage has an endpoint, and it's to care for one another in a way that is fully human." So true.
A must read for anyone involved in healthcare--whether as a professional or patient.
I received a complimentary ARC from W. Norton & Company, and all opinions expressed are my own. Publication in July 2023.
March 9, 2024
Outstanding book. It was extremely well written, gripping, and relevant in our modern US climate with frustrating healthcare systems. The author offers well-thought out solutions, such as prioritizing and increasing the funding for primary care, connecting important data, and thinking holistically about a patient’s story. I hope the right people read this book, so that we can take steps to work toward these actions.
Reading this book makes me thankful for doctors and nurses. It also brings attention to the cultural issue our country has with overworking and burnout (across multiple industries, including teaching [from personal history] and healthcare. Mental health, boundaries, and work-life boundaries need to continue to be an ongoing, high-priority focus moving forward. Again, this was a worthwhile read, and I highly recommend this book.
Reading this book makes me thankful for doctors and nurses. It also brings attention to the cultural issue our country has with overworking and burnout (across multiple industries, including teaching [from personal history] and healthcare. Mental health, boundaries, and work-life boundaries need to continue to be an ongoing, high-priority focus moving forward. Again, this was a worthwhile read, and I highly recommend this book.
August 30, 2023
This was just published this year. It is a wonderful journal of the extreme difficulty of giving competent, compassionate health care in the fragmented world of American medicine. It should be required reading for every nurse, doctor, health care providers of all stripes, and especially, every politician in America. Understanding the complexity and difficulty of medical decisions and patient care is essential to being a good spouse, parent, grandchild, citizen, and policy-maker. Please read. The stories are gripping and heart-rending. You will cheer and cry. Thank you for putting all that I have ever felt as a family nurse practitioner into words, Dr. Yurkiewicz. Your patients are blessed by your insight and intelligence.
October 3, 2024
Without a doubt among the most important nonfiction I have ever read. Extremely insightful about the fragmentations of the medical system and how it poorly affects doctors and patients. Offers many concrete ways that the medical system could improve if we are brave enough to choose systemic and institutional changes. The writing itself was gripping, thought-provoking, and honest, making it difficult to put down. This is a book that I strongly believe everyone who engages with the American healthcare system would benefit from reading to better understand the intricacies of the system responsible for our care, well-being, and lives. Extremely impressed with Dr. Yurkiewicz and eager to read more from her in the future.
November 29, 2023
Well-written account of what goes wrong in the US healthcare system, including examples from the author's own experience. I did not find much new ground here, however. Others have documented the hazards of electronic medical records that don't transfer easily between healthcare systems, sometimes leaving major gaps and potential minefields in the patient's medical history. Dr. Yurkiewicz also makes a strong case that everyone should have a primary care provider who serves as gatekeeper for their overall health and pushes for patients and their families taking a more proactive role in decision-making and managing treatment.
August 21, 2023
Brilliant
This is a beautifully written book that is a must read for physicians and patients (all of us). This book needed to be written and this author was up to the task. She accurately describes what it’s like to be a physician while also nailing the problems with our health care system and gives solutions to said problems. I appreciated her weaving in the story of her own father’s illness with stories of her own patients. Very moving and very relatable. Health care affects us all and reading this book is a step toward understanding it and working to get it right.
This is a beautifully written book that is a must read for physicians and patients (all of us). This book needed to be written and this author was up to the task. She accurately describes what it’s like to be a physician while also nailing the problems with our health care system and gives solutions to said problems. I appreciated her weaving in the story of her own father’s illness with stories of her own patients. Very moving and very relatable. Health care affects us all and reading this book is a step toward understanding it and working to get it right.
March 10, 2024
Every American should read this book. Ilana Yurkiewicz takes on the most complex and intractable issues in our society through patient stories, personal vignettes, and communicating scientific studies. I love how she interweaves stories to make her points, and I love that these points are both straightforward and personally actionable. The relatively small changes she proposes for healthcare seem absolutely obvious, doable, and destined to have outsized impact. I hope to see these societal changes occur, and as I start my career Dr. Yurkiewicz's ideas will guide how I work in this industry.
October 5, 2023
So well written. As a physician this is 100% relatable but communicated in a way that non-medical readers can appreciate the depth and complexities involved in taking care of patients within a broken system. Images of busy ICUs, doctors working two phones and one computer trying to sort out difficult situations … this book sheds light on what is broken as well as what is beautiful about medicine. We must do better. We want to do better. I just hope we find a way.
January 24, 2024
This book covers how broken the healthcare system is in terms of fragmentation—how information slips through the cracks for a multitude of reasons, sometimes with catastrophic results (inability to see records from other hospitals/systems, 28 hour shifts for doctors, etc). It’s a call to action to change these things and better serve patients. I thought it was well written and thought provoking, as well as familiar being in the medical profession.
February 22, 2024
This was a fantastic read on fragmentation within medicine. As a former hospital chaplain and now system mission leader, I was not surprised by the areas of fragmentation that Dr. Yurkiewicz presents, but I was surprised at how pervasive the divides are.
(For instance, when you're a patient in the hospital, you will be cared for by a team of physicians who don't always know your full story or consult with each other)
I'll be thinking about this book for a long time to come!
(For instance, when you're a patient in the hospital, you will be cared for by a team of physicians who don't always know your full story or consult with each other)
I'll be thinking about this book for a long time to come!
April 1, 2024
Some great perspectives given about the broken healthcare system from the point of view of the physician. There were some real heartfelt moments in this book. I would have liked to see more proposed solutions and brainstorming than a quick blurb of suggestions on the last page of the book. Perhaps there will be a follow-up book?
April 9, 2024
Yes, American healthcare is fragmented. Rather than touting her doing primary care for oncology and other patients, she needs to look at the bigger picture of advocating for single payer healthcare. Also residents hours have been curtailed.
July 2, 2023
Fragmented is an interesting story about health care in American.
July 19, 2023
A book on how if doctors do not have all your information your health care could be in peril
Read
August 23, 2023My interview with Dr. Ilana Yurciewicz for The Armen Show:
http://www.armenshirvanian.com/podcas...
http://www.armenshirvanian.com/podcas...
September 3, 2023
This could have been a dry book of studies and statistics but patient’s stories extremely interesting
November 16, 2023
Incredibly thought provoking yet accessible. Round up from a 4.5
January 14, 2024
A very well written book on the trouble with the current healthcare system. She uses a lot of interesting stories to make salient points.
January 22, 2024
very interesting
January 29, 2024
What an eye-opening book. 28-hour shifts, really?!
April 2, 2024
Best book I have read on the health care system in the United States. A must read for anyone who has either been in the hospital or taken a loved one there.
August 10, 2023
This book presented an incredible wealth of information regarding a side to the healthcare world that I simply don’t have access to. The presentation of information was done spectacularly. The anecdotes used to support all the arguments along the way made the underlying motives for writing this book relatable and compelling. Yurkiewicz is a personable and extremely intelligent writer.
Displaying 1 - 30 of 33 reviews